Alcohol expectancies and drinking refusal self-efficacy mediate the association of impulsivity with alcohol misuse

A new approach to urinalysis: effectiveness of a contingency management program among adolescent offenders in Spain

Background

When addressing antisocial behaviour among adolescents, programs based on the paradigm of positive psychology through enhancing self-efficacy have demonstrated their effectiveness in furthering the positive development of young people with a history of antisocial behaviour. Nevertheless, there has been little research into the effectiveness of these type of programs in mitigating substance abuse among juvenile offenders. The aim of this paper is to analyse the effectiveness of a contingency management program in reducing the prevalence of relapses into drug consumption among adolescents who have committed serious crimes.

Methods

The study consisted of a sample of 91 male adolescents, between 15 and 19 years, in juvenile detention, who were divided into two treatment groups. For both groups, biological testing was used to detect drug consumption upon their re-turn from leave permits from the Centre.

Results

The quasi-experimental group had significantly lower rates of relapse than the quasi-control group. Furthermore, being part of the quasi-experimental group was a significant predictor of reduced rates of relapses.

Conclusion

The results suggest that the incorporation of treatment strategies which reinforce feelings of self-efficacy and adequate orientation towards the future, as a complement to disciplinary sanctions, are effective in reducing relapses in drug use among adolescent offenders.

College Student Alcohol Use: Understanding the Role of Alcohol Expectancies, Social Anxiety, Social Connectedness, and Need to Belong

ObjectiveCollege students consume more alcohol and engage in binge drinking more frequently than their non-college attending peers, and prevalence of alcohol-related consequences (e.g., drinking and driving; taking avoidable risks) has not decreased proportionally with decreases in consumption. Social anxiety and alcohol expectancies, or beliefs about the effects of alcohol, have been found to be significantly related to alcohol use and account for significant variance in alcohol use and related consequences. Few studies, however, have examined how other social variables such as need to belong and social connectedness may fit into existing models of increased and risky alcohol use. Methods: Students at a large state university (n = 1,278) completed an online survey measuring alcohol expectancies, need to belong, social anxiety, and social connectedness. Mean age of participants was 19.65 years, and 59.5% self-identified as female, 39.8% male, and 0.7% identified as transgender. Structural equation modeling supported hypothesized relationships between need to belong, social anxiety, social connectedness, alcohol expectancies, and alcohol use, a mean centered variable that included binge drinking, drinking frequency, and amount of consumption. Results: Positive alcohol expectancies related to tension reduction, sociability, and sexuality, were positively related to drinking, such that increased alcohol expectancies were associated with increased drinking. Alcohol expectancies mediated the relationship between need to belong and increased alcohol use, as well as social connectedness and increased alcohol use. Similarly, social anxiety also mediated these relationships. No direct relationships were found between need to belong or social connectedness and alcohol use, suggesting previous research exploring these relationships may have excluded control variables (e.g., biological sex, race/ethnicity) that better explain the impact of need to belong and social connectedness on alcohol use. Conclusion: Prevention and intervention efforts might be more effective in reducing alcohol use if social factors are more broadly targeted.

Health-Related Cognitions and Metacognitions Indirectly Contribute to the Relationships Between Impulsivity, Fear of COVID-19, and Cyberchondria

The aim of the study was to converge a structural equation model to unfold the compositive relationships between trait impulsivity, health cognitions, metacognitions about health, fear of COVID-19 and cyberchondria, after controlling for gender, age, marital status, having a chronic illness and chronic illness among first-degree relatives. Six hundred fifty-one participants (423 females, 65%; 228 males, 35%) participated in the study. The Short UPPS-P Impulsive Behavior Scale (S-UPPS-P), Health Cognitions Questionnaire (HCQ), The Meta-Cognitions about Health Questionnaire (MCQ-HA), Cyberchondria Severity Scale -Short Form (CSS-12), and Fear of COVID-19 Scale (FCV-19 S) were completed by volunteered participants. The structural model showed that the S-UPPS-P directly and indirectly contributed to the HCQ, MCQ-HA, CSS-12, and FCV-19 S. The multi-group structural analysis by gender showed that the structural model had a partial measurement and factorial invariance. We concluded that the significant associations between impulsivity, fear of COVID-19 and cyberchondria were indirectly contributed by health-related cognitions and metacognitions.

Alcohol mixed energy drink usage and risk-taking among college students in Western New York State

Alcohol mixed energy drinks (AmED) may promote excessive alcohol intake and risk-taking among college students. Objective: To understand the relationship between AmED use and risky behavior as well as attitudes and motivations for AmED use. Participants: Undergraduate college students N = 422 (Study 1), N = 37 (Study 2). Methods: Using a mixed-methods approach, we first surveyed undergraduate students about their AmED and alcohol consumption and a series of risk behaviors, self-efficacy, and beliefs (Study 1). We then conducted focus groups within the same population to better understand attitudes, knowledge, and motivations for using AmED (Study 2). Results: Recent AmED use was significantly associated with an increased number of reported binge drinking occasions and self-reported driving while intoxicated events. Our qualitative data analyses revealed two major themes associated with AmED consumption: factors encouraging AmED use and decisions about driving while under the influence of alcohol. Conclusions: These findings add to the literature of beliefs and motivations for AmED use among college students.

“The Best Laid Plans”: Do Individual Differences in Planfulness Moderate Effects of Implementation Intention Interventions?

While there is good evidence supporting the positive effect of planning strategies like implementation intentions on the relationship between intention and behavior, there is less evidence on the moderating role of individual differences in planning capacity on this effect. This study aimed to examine the role of individual differences in planfulness on the effect of planning strategies on the intention–behavior gap. Specifically, this study investigated the influence of planfulness on the effectiveness of implementation intentions on goal-directed behavior using an experimental design. Undergraduate university students (N = 142) with high and low levels of planfulness based on a priori scores on a planfulness measure were randomized to either a planning (implementation intention) or familiarization (control) condition prior to completing a computerized go no-go task. We predicted that individuals reporting low levels of planfulness would be more effective in executing goal-directed behavior when prompted to form an implementation intention compared to individuals who do not receive a prompt. Additionally, we predicted that individuals reporting high planfulness would be equally effective in enacting goal-directed behaviour regardless of whether they formed an implementation intention. The results revealed no main or interaction effects of implementation intention manipulation and planfulness on task reaction times. The current results do not provide support for the moderating effect of planfulness on the implementation effect. The findings of this study were inconsistent with previous literature. This research has implications for the effectiveness of implementation intentions, as well as opportunities for further replication in a novel research area.

Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study

Background

Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors’ harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time.

Objective

This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China.

Methods

An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD.

Results

The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%).

Conclusions

Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted.

A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill

OBJECTIVES

The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE).

METHODS

A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients.

RESULTS

The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates.

SIGNIFICANCE OF RESULTS

This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill.

Metadehumanization and Self-dehumanization are Linked to Reduced Drinking Refusal Self-Efficacy and Increased Anxiety and Depression Symptoms in Patients with Severe Alcohol Use Disorder

Metadehumanization, the perception of being treated as less than a human by others, is a pervasive phenomenon in intergroup relations. It is dissociated from stigmatization or stereotypes, and it has been recently identified as a critical process in severe alcohol use disorders (SAUD). Metadehumanization is associated with a wide array of negative consequences for the victim, including negative emotions, aversive self-awareness, cognitive deconstruction, and psychosomatic strains, which are related to anxiety and depression. This study aims to investigate if metadehumanization occurring among patients with SAUD is associated with clinical factors involved in the maintenance of the disease, namely symptoms of depression or anxiety and drinking refusal self-efficacy. A cross-sectional study was conducted among 120 patients with SAUD. Self-reported questionnaires measured metadehumanization, self-dehumanization (i.e., the feeling of being less than a human), anxiety, depression, drinking refusal self-efficacy, and demographics. Metadehumanization was significantly associated with self-dehumanization, anxiety, depression, and drinking refusal self-efficacy. Additionally, path analyses showed that self-dehumanization mediated the links between metadehumanization and clinical variables. These results indicate that metadehumanization and self-dehumanization could be essential factors to consider during SAUD treatment, as they are associated with increased psychiatric symptoms and reduced drinking refusal self-efficacy.

Precision Mental Health Care for Cannabis Use Disorder: Utility of a bioSocial Cognitive Theory to Inform Treatment

Globally, cannabis is the most frequently used controlled substance after alcohol and tobacco. Rates of cannabis use are steadily increasing in many countries and there is emerging evidence that there is likely to be greater risk due to increased concentrations of delta-9-tetrahydrocannabinol (THC). Cannabis use and Cannabis Use Disorder (CUD) has been linked to a wide range of adverse health outcomes. Several biological, psychological, and social risk factors are potential targets for effective evidence-based treatments for CUD. There are no effective medications for CUD and psychological interventions are the main form of treatment. Psychological treatments based on Social Cognitive Theory (SCT) emphasize the importance of targeting 2 keys psychological mechanisms: drug outcome expectancies and low drug refusal self-efficacy. This mini-review summarizes the evidence on the role of these mechanisms in the initiation, maintenance, and cessation of cannabis use. It also reviews recent evidence showing how these psychological mechanisms are affected by social and biologically-based risk factors. A new bioSocial Cognitive Theory (bSCT) is outlined that integrates these findings and implications for psychological cannabis interventions are discussed. Preliminary evidence supports the application of bSCT to improve intervention outcomes through better targeted treatment.

A model of reinforcement sensitivity, impulsivity, alcohol use, and risky sexual behavior in a sample of young adult drinkers

This study tested a structural equation model linking reinforcement sensitivity to subsequent emotion-based impulsivity (i.e., positive and negative urgency), alcohol use, and risky sexual behavior among a sample of 753 undergraduate drinkers. A hypothesized Sensitivity to Punishment (SP) × Sensitivity to Reward (SR) interaction significantly predicted both positive and negative urgency. At low levels of SR, SP had a significant negative effect on positive urgency and a significant positive effect on negative urgency. However, at high levels of SR, SP had significant positive effects on both types of urgency. Results indicated that positive and negative urgency mediate the associations between reinforcement sensitivity and both alcohol use and risky sexual behavior. Moreover, results demonstrated that at low levels of SR, SP is indirectly associated with decreased alcohol use. However, as SR increases, SP is indirectly associated with increased alcohol use and risky sexual behavior, due to the joint effect of high SP and SR on emotion-based impulsivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

From Impulse to Action? Cognitive Mechanisms of Impulsivity-Related Risk for Externalizing Behavior

Trait impulsivity is an established risk factor for externalizing behavior problems in adolescence, but little is understood about the cognitive mechanisms involved. Negative automatic thoughts are associated with externalizing behaviors and impulsivity is associated with less cognitive reappraisal. This study sought to adapt the bioSocial Cognitive Theory (bSCT) of impulsivity and substance use (an externalizing behavior) for externalizing behavior in general. It was predicted that only the component of impulsivity characterized by lack of forethought (rash impulsiveness; RI) would be associated with (non-substance use-related) externalizing behaviors, not reward sensitivity/drive. Further, this association would be mediated by negative automatic thoughts. Participants were 404 (226 female, 63%) adolescents from 6 high schools across South-East Queensland (age = 13-17 years, mean age = 14.97 years, SD = 0.65 years) of mostly Australian/New Zealand (76%) or European (11%) descent. Participants completed self-report measures of impulsivity, negative automatic thoughts, and externalizing behaviors. Path analysis revealed that, as predicted, only RI was uniquely associated with negative automatic thoughts and externalizing behaviors. However, only negative automatic thoughts centered around hostility mediated the positive association between RI and externalizing behaviors, with the indirect mediation effect being smaller than the direct association. In contrast to substance use, only one component of impulsivity, RI, was associated with general adolescent externalizing behavior. Hostile automatic thoughts may be an important mechanism of risk, supporting a role for cognitive-behavioral interventions. Other biopsychosocial mechanisms are clearly involved and the bSCT may provide a useful framework to guide future research.

Individual differences in impulsivity and need for cognition as potential risk or resilience factors of diabetes self-management and glycemic control

Objective

Impulsivity is marked by insufficient reflection and forethought, whereas Need for Cognition (NFC) also referred to as cognitive motivation or intellectual engagement is marked by elaborated thinking. The aim of this study was to investigate the potential role of these personality traits as resilience or risk factors, respectively, in diabetes self-management and glycaemic control. Further, it was examined whether diabetes-specific self-efficacy could serve as a mediator of these relationships.

Design/Measures

Data of 77 participants with type 2 diabetes was ascertained, using self-report instruments for NFC, impulsivity, diabetes-specific self-efficacy, and diabetes self-management. Glycemic control was assessed by the biomarker HbA_1c.

Results

While NFC was strongly positively associated with diabetes self-management and glycemic control, impulsivity showed a reverse pattern. Results of simple and serial mediation models showed that the effects on diabetes self-management and HbA1c of both, impulsivity and NFC, were mediated by self-efficacy.

Conclusion

The moderate to high standardized coefficients suggests that NFC might be an important protective factor and impulsivity a possible risk factor for effective diabetes self-management and glycemic control. These traits could be applied for an easy-to-use questionnaire-based patient screening, enabling trait-tailored treatments and programs which in turn may lower economic and health costs associated with poor diabetes-care.

Development of the Substance Use Motives Measure (SUMM): A comprehensive eight-factor model for alcohol/drugs consumption

A wide range of literature (e.g. Cooper, Kuntsche, Levitt, Barber, & Wolf, 2016) supports the assumption that substance use behaviors are driven by different needs, such as socializing with friends or escaping negative mood, that result in diverse consequences. Starting from the four factors identified by Cooper (1994), in the present research we developed the Substance Use Motives Measure (SUMM). SUMM identifies eight motives for alcohol and substance use (Enhancement, Social, Conformity, Anxiety-Coping, Depression-Coping, Boredom-Coping, Self expansion and Performance) that are assumed to be differentially related to specific patterns of substance use. The current study is a preliminary investigation of the psychometric properties of the SUMM in a nonclinical sample. The results support the internal reliability and validity of the measure and suggest that the eight motives may be linked to the use of diverse substances through different reinforcement processes. Additional results show distinct patterns of correlations between the eight motives and personality traits, as an indication of different profiles of alcohol-drug consumers. This flexible assessment measure may have important implications for research, prevention and clinical interventions.

A Multilevel Study of Alcohol Consumption in Young Adults: Self-Efficacy, Peers' Motivations and Protective Strategies

In both developing and underdeveloped countries there has been a worrying increase in the number of young people drinking alcohol; this public health problem warrants more research. This multilevel study analyzed the influence of drinking refusal self-efficacy, peers’ motivation, and protective behavioral strategies as predictors of alcohol consumption in a sample of 261 young people arranged into 52 social groups (peers who regularly shared leisure activities). A series of questionnaires were administered individually to evaluate beliefs and behaviors related to alcohol consumption at both individual level (drinking refusal self-efficacy) and peer level (enhancement motivation and protective behavioral strategies). The results showed that the individual variable (drinking refusal self-efficacy) predicted alcohol consumption behaviors. The multilevel design allowed us to evaluate the direct and moderated effects of peers’ enhancement motivation and protective behavioral strategies on the relationship between self-efficacy and drinking behavior. These results show the importance of developing cognitive, behavioral, and educational intervention programs to increase young people and university students’ confidence and ability to use protective strategies, in order to reduce alcohol use.

Self-Efficacy to Limit Drinking Mediates the Association between Attitudes and Alcohol-Related Outcomes

Personal attitudes toward alcohol consumption are reliable predictors of alcohol use and related problems, with emerging work suggesting that one's favorable attitude toward limited drinking (i.e., at levels below the threshold for heavy episodic drinking) is a buffer against alcohol use and binge drinking. However, little work has examined the specific mechanism(s) through which one's personal attitude toward limited drinking is associated with alcohol use and related problems. One such mechanism may be an individual's self-efficacy to limit their alcohol use. The current study aimed to evaluate whether self-efficacy to limit one's alcohol use mediates the association between one's personal attitude toward limited drinking and actual alcohol use and related problems over time. Participants were mandated students (n = 568; 28% female) who violated campus alcohol policy and received a brief motivational intervention. Mediation models were used to test (a) self-efficacy to limit one's alcohol use as a traditional mediator of the attitudes-drinking quantity association and (b) self-efficacy and drinking quantity as serial mediators of the attitudes-alcohol-problems link. Favorable attitudes toward limiting drinking at baseline were positively associated with self-efficacy to limit drinking at 1 month, which was associated with a reduction in drinking quantity at 3 months; this, in turn, was associated with a reduction in alcohol-related problems at 5 months. These findings provide a rationale for incorporating attitudes and self-efficacy in the development and refinement of intervention strategies.

Transdiagnostic Investigation of Impulsivity in Alcohol Use Disorder and Binge Eating Disorder With Eye-Tracking Methodology-A Pilot Study

Objective: Patients with alcohol use disorder (AUD) and patients with binge eating disorder (BED) are characterized by increased impulsivity, i.e. increased reward sensitivity and diminished response inhibition. In this pilot study, we compare both disorders directly concerning impulsivity using disorder-specific stimuli to gain insight into the relationship of both disorders and underlying mechanisms. Methods: We compared eye movements of 23 women with BED (age M = 40.9), 21 participants with AUD (13 females, 8 males, age M = 46.6), and age- and sex-matched control groups (BED-CG and AUD-CG, respectively). We measured reward sensitivity with the free exploration paradigm and response inhibition with the modified antisaccade paradigm. We presented disorder-specific stimuli vs. neutral stimuli, i.e. food stimuli in the BED and BED-CG and alcohol stimuli in the AUD and AUD-CG. Results: BED and BED-CG initially fixated more often on food stimuli vs. neutral stimuli, whereas AUD and AUD-CG initially fixated more often on neutral stimuli vs. alcohol stimuli. AUD showed shorter dwell times on both stimulus categories in comparison with the other groups. When saccades towards stimuli should be inhibited, BED made more errors in first saccades for both stimulus categories in comparison with AUD-CG and in second saccades particularly for food stimuli in comparison with all other groups, whereas AUD did not differ from the control groups. Conclusions: This pilot study indicates that food and alcohol stimuli are at the first sight differently processed. Moreover, patients with BED and with AUD seem to process disorder-specific stimuli differently. Whereas patients with AUD avoid stimuli generally, patients with BED predominantly show deficits in inhibitory control.

A Randomized Trial of Personalized Cognitive-Behavior Therapy for Alcohol Use Disorder in a Public Health Clinic

Background: Tailored psychological interventions based on individual risk factors are likely to improve treatment for Alcohol Use Disorders (AUDs). Key risk factors for poor treatment outcome include alcohol craving, positive expectations of alcohol consumption, and impulsivity. Design: Pragmatic randomized Cognitive-Behavioral Treatment (CBT) trial. Setting: Public hospital alcohol and drug clinic. Participants: Three-hundred seventy-nine patients (65% male; AgeyearsM = 44.32, SD = 10.75) seeking treatment for AUD. Procedure: Patients were randomly allocated into treatment as usual (TAU) or targeted treatment. Patients in targeted treatment were allocated one of three treatment modules focusing on craving, positive expectancy, or impulsivity based on assessment results. Treatment included eight, 1 h sessions of CBT over 12 weeks delivered by clinical psychologists. Hypotheses: Targeted treatment was expected to have fewer drinking days and consume less alcohol during the treatment period than TAU. Improvement in targeted mechanisms was predicted to be greatest for patients within matched conditions. Results: Patients attended an average of 4.4 sessions with 93 (25%) completing the whole 12-week treatment episode. The mean proportion of drinking days between sessions was 5% with an average consumption of 64 grams of ethanol. No significant effect of targeted treatment was identified on drinking days or consumption. The craving (b = -18.97, 95% CI = -31.44, -6.51) and impulsivity (b = -26.65, 95% CI = -42.09, -11.22) modules demonstrated significant reductions in their targeted constructs over treatment, above TAU. Only reduction in craving was associated with reduced drinking days [exp(b) = 0.958, p = 0.003] and alcohol consumption [exp(b) = 0.962, p = 0.02]. Significant indirect effects for the targeted craving module through craving reduction were identified for reduction in drinking days (β = -0.72, 95% CI = -1.50, -0.158) and alcohol consumption (β = -0.78, 95% CI = -1.72, -0.11). Conclusions: In the context of a public health service, the effectiveness of individualized treatment targeting risk mechanisms identified during pre-treatment assessment was not confirmed. Some evidence was found for improved treatment response to the implementation of a manualized craving module when pre-treatment craving was high.

Validation of the Adolescent Drinking Expectancy Questionnaire and development of a short form

AIMS

This study aimed to validate the Drinking Expectancy Questionnaire-Adolescent version (DEQ-A) in a large adolescent sample and to develop and validate a brief measure, the Drinking Expectancy Questionnaire-Shortened Adolescent version (DEQ-SA).

DESIGN AND METHODS

Cross-sectional survey of secondary school students (n = 2357, aged 13-16, M = 14.66 years, SD = 0.60). Students completed the DEQ-A in school, and measures of alcohol consumption including the Alcohol Use Disorders Identification Test-Consumption. The data were randomly split, and Exploratory Factor Analysis was performed using subsample 1, and Confirmatory Factor Analysis and reliability and validity testing were performed using subsample 2.

RESULTS

The 24-item DEQ-A was successfully reduced to 12 items (DEQ-SA) without compromising psychometric properties. The DEQ-A and the DEQ-SA both demonstrated adequate-to-good fit to the data and very good internal reliability. The DEQ-A and DEQ-SA explained 20 and 18% of the variance in alcohol consumption. Adolescents who drank endorsed more positive alcohol expectancies, whereas alcohol-naïve adolescents scored higher on negative alcohol expectancies. As the DEQ-SA comprises two subscales of the DEQ-A, the endorsement rates are applicable to both scales.

DISCUSSION AND CONCLUSIONS

The DEQ-A and the short form of this scale developed in this study (DEQ-SA) show good reliability, internal structure and account for a large proportion of variance in alcohol consumption. Both scales can assist in targeting cognitive change processes within tailored alcohol prevention and treatment approaches, and investigating hypothesised mechanisms of change. The DEQ-SA is recommended for more time-limited environments. [Patton KA, Connor JP, Rundle-Thiele S, Dietrich T, Young RM, Gullo MJ. Validation of the Adolescent Drinking Expectancy Questionnaire and development of a short form.

Sex differences in the interacting roles of impulsivity and positive alcohol expectancy in problem drinking: A structural brain imaging study

Alcohol expectancy and impulsivity are implicated in alcohol misuse. However, how these two risk factors interact to determine problem drinking and whether men and women differ in these risk processes remain unclear. In 158 social drinkers (86 women) assessed for Alcohol Use Disorder Identification Test (AUDIT), positive alcohol expectancy, and Barratt impulsivity, we examined sex differences in these risk processes. Further, with structural brain imaging, we examined the neural bases underlying the relationship between these risk factors and problem drinking. The results of general linear modeling showed that alcohol expectancy best predicted problem drinking in women, whereas in men as well as in the combined group alcohol expectancy and impulsivity interacted to best predict problem drinking. Alcohol expectancy was associated with decreased gray matter volume (GMV) of the right posterior insula in women and the interaction of alcohol expectancy and impulsivity was associated with decreased GMV of the left thalamus in women and men combined and in men alone, albeit less significantly. These risk factors mediated the correlation between GMV and problem drinking. Conversely, models where GMV resulted from problem drinking were not supported. These new findings reveal distinct psychological factors that dispose men and women to problem drinking. Although mediation analyses did not determine a causal link, GMV reduction in the insula and thalamus may represent neural phenotype of these risk processes rather than the consequence of alcohol consumption in non-dependent social drinkers. The results add to the alcohol imaging literature which has largely focused on dependent individuals and help elucidate alterations in brain structures that may contribute to the transition from social to habitual drinking.

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Alcohol expectancy (AE) and impulsivity are risk factors for problem drinking.

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AE mediates the correlation between right insula GMV and problem drinking in women.

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AE and impulsivity interacts to mediate left thalamus GMV and problem drinking in all.

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Models where changes in GMV as a result of problem drinking are not supported.

The Association between Alcohol and Sexual Risk Behaviors among College Students: A Review

PURPOSE OF REVIEW

Alcohol use is prevalent among college students and may contribute to sexual risk behavior engagement. A narrative review of the recent empirical literature examining the association between alcohol use and sexual risk behaviors among college student samples was conducted. The purpose of this review was to: (a) review studies examining the association between alcohol use and risky sexual behaviors; and (b) overview research investigating alcohol expectancies and partner characteristics as factors that may influence the alcohol-risky sex relation among college students.

RECENT FINDINGS

Findings regarding the direct link between alcohol use and sexual risk behaviors were mixed. Results suggest a more nuanced association between alcohol and risky sexual behaviors that is influenced by alcohol expectancies and partner characteristics.

SUMMARY

Results highlight the importance of considering additional factors that may influence the alcohol-risky sex relation. Future interventions targeting alcohol-related sexual risk behavior engagement among college students are needed.

Acute subjective response to alcohol as a function of reward and punishment sensitivity

Individual differences in subjective response to alcohol play a crucial role in the development of heavy drinking and related problems. In light of this, a growing focus of research has been identifying factors that contribute to differences in response. The aim of the present study was to determine whether individual differences in the subjective experience of rewarding and aversive effects of alcohol are a specific manifestation of general differences in reward and punishment sensitivity. Eighty-nine participants (M age=22.4, SD=1.9; 47.2% women) consumed a moderate dose of alcohol, i.e., peak breath alcohol concentration (BrAC)≈0.080g%, and rated their level of stimulation and sedation at seven timepoints over the BrAC curve. Sensitivity to reward and punishment were assessed by a self-report questionnaire prior to consumption. Multilevel growth models showed that post-consumption changes in stimulation ratings varied as a function of participants' level of reward and punishment sensitivity. Drinkers more sensitive to reward reported feeling more stimulated shortly after drinking and exhibited an attenuated rate of decline in stimulation over the blood alcohol curve, relative to drinkers with less strong reward sensitivity. Reward sensitivity was not related to subjective ratings of sedation, and punishment sensitivity was not related to either stimulation or sedation ratings. Findings suggest that reward sensitivity may increase risk for alcohol misuse among young adult social drinkers by increasing their subjective feelings of stimulation while drinking.

An evolutionary perspective on the co-occurrence of social anxiety disorder and alcohol use disorder

Social Anxiety Disorder (SAD) commonly co-occurs with, and often precedes, Alcohol Use Disorder (AUD). In this paper, we address the relationship between SAD and AUD by considering how natural selection left socially anxious individuals vulnerable to alcohol use, and by addressing the underlying mechanisms. We review research suggesting that social anxiety has evolved for the regulation of behaviors involved in reducing the likelihood or consequences of threats to social status. The management of potential threats to social standing is important considering that these threats can result in reduced cooperation or ostracism - and therefore to reduced access to coalitional partners, resources or mates. Alcohol exerts effects upon evolutionarily conserved emotion circuits, and can down-regulate or block anxiety (or may be expected to do so). As such, the ingestion of alcohol can artificially signal the absence or successful management of social threats. In turn, alcohol use may be reinforced in socially anxious people because of this reduction in subjective malaise, and because it facilitates social behaviors - particularly in individuals for whom the persistent avoidance of social situations poses its own threat (i.e., difficulty finding mates). Although the frequent co-occurrence of SAD and AUD is associated with poorer treatment outcomes than either condition alone, a richer understanding of the biological and psychosocial drives underlying susceptibility to alcohol use among socially anxious individuals may improve the efficacy of therapeutic interventions aimed at preventing or treating this comorbidity.

Influence of Parental Monitoring, Sensation Seeking, Expected Social Benefits, and Refusal Efficacy on Tobacco and Alcohol Use in Chinese Adolescents

The relationships between parental monitoring (PM), sensation seeking (SS), expected social benefits (ESB), refusal efficacy (RE), and tobacco and alcohol use (TAU) have been well documented among adolescents. However, the mechanisms by which these 4 determinants affect TAU remain unclear. Based on the Theory of Triadic Influence, this study aimed to explore how PM, SS, ESB, and RE simultaneously influenced TAU in Chinese adolescents. From September 2013 to June 2014, we used multistage cluster sampling to select 6269 students from 179 classes of 7 vocational high schools in 3 cities of China. Each student completed a battery of 5 measures: PM, SS, ESB, RE, and TAU. Then, we used structural equation modeling techniques and mediation analyses to investigate the relationships among these 5 measures, with TAU as the final dependent variable. Results demonstrated that the relationship between PM and TAU was fully mediated by ESB and RE (b = -0.18, P < 0.001), that SS influenced TAU directly (b = 0.10, P < 0.001) and indirectly through ESB and RE (b = 0.15, P < 0.001), and that ESB influenced TAU directly (b = 0.09, P < 0.001) and indirectly through RE (b = 0.28, P < 0.001).These findings indicate that the link between PM and SS to TAU among Chinese adolescents can be explained by ESB and RE. These 4 precursory determinants can play an important role in TAU prevention among adolescents in China.

The road to drink is paved with high intentions: Expectancies, refusal self-efficacy, and intentions among heavy drinking college students

The present study examined the effects of drinking intentions (DI) on alcohol expectancies (AE) and drink refusal self-efficacy (DRSE) in regard to alcohol consumption among heavy drinking undergraduates. Research shows that DRSE buffers against drinking (Young, Hasking, Oei, & Loveday, 2007) and interacts with AE to predict alcohol consumption (Oei & Burrow, 2000). Studies further show that DI is predicted by DRSE (Norman, 2011) and AE (Fleming, Thorson, & Atkin, 2004). However, additional research is needed to understand DI's influence on both DRSE and AE among heavy college drinkers. This research included 344 heavy drinking college students (mean age = 23.06 years, SD = 5.61, 74.71% female) from a large southern university who completed study material as part of a larger intervention. Findings showed that DI, DRSE, and AE interacted with respect to heavy drinking such that DRSE was negatively associated with alcohol consumption, particularly among those low in positive AE and high in negative AE. This relationship was stronger among individuals low in DI relative to those high in DI. DI seems to be an important factor influencing heavy drinking among undergraduate students. Present findings further support DI's associations with heavy drinking, regardless of an individual's DRSE or AE. Implications of this research suggest that it may be beneficial for interventions to target specific aspects of AE, including anxious drinking.

Alcohol Expectancies Mediate and Moderate the Associations between Big Five Personality Traits and Adolescent Alcohol Consumption and Alcohol-Related Problems

Personality and expectancies are relevant psychological factors for the development of adolescent alcohol use and misuse. The present study examined their direct, mediated and moderated effects on different drinking behaviors in adolescence. Personality domains of the five-factor model, positive and negative alcohol expectancies (AEs), alcohol use during the week and the weekend, and alcohol-related problems were assessed in a sample of 361 adolescents. Different personality dimensions were directly associated with specific alcohol outcomes: Extraversion, low Conscientiousness and low Openness were associated with weekend alcohol use; low Agreeableness was related to weekday use; whereas low Agreeableness, low Conscientiousness and Extraversion were associated with alcohol-related problems. In addition, positive AEs mediated the relationship between Extraversion and alcohol use, whereas both positive and negative expectancies mediated the association between Neuroticism and alcohol consumption and alcohol-related problems. Finally, both types of expectancies interacted with Extraversion to predict alcohol problems. Our results highlight the importance of examining the complex interplay of comprehensive personality models and AEs to gain a better understanding of the development of different alcohol use and misuse patterns in adolescence.

Gray matter volume correlates of global positive alcohol expectancy in non-dependent adult drinkers

Alcohol use and misuse is known to involve structural brain changes. Numerous imaging studies have examined changes in gray matter (GM) volumes in dependent drinkers, but there is little information on whether non-dependent drinking is associated with structural changes and whether these changes are related to psychological factors-such as alcohol expectancy-that influence drinking behavior. We used voxel-based morphometry (VBM) to examine whether the global positive scale of alcohol expectancy, as measured by the Alcohol Expectancy Questionnaire-3, is associated with specific structural markers and whether such markers are associated with drinking behavior in 113 adult non-dependent drinkers (66 women). Alcohol expectancy is positively correlated with GM volume of left precentral gyrus (PCG) in men and women combined and bilateral superior frontal gyri (SFG) in women, and negatively correlated with GM volume of the right ventral putamen in men. Furthermore, mediation analyses showed that the GM volume of PCG mediate the correlation of alcohol expectancy and the average number of drinks consumed per occasion and monthly total number of drinks in the past year. When recent drinking was directly accounted for in multiple regressions, GM volume of bilateral dorsolateral prefrontal cortices correlated positively with alcohol expectancy in the combined sample. To our knowledge, these results are the first to identify the structural brain correlates of alcohol expectancy and its mediation of drinking behaviors. These findings suggest that more studies are needed to investigate increased GM volume in the frontal cortices as a neural correlate of alcohol expectancy.

Alcoholics Anonymous and reduced impulsivity: a novel mechanism of change

ABSTRACT   Reduced impulsivity is a novel, yet plausible, mechanism of change associated with the salutary effects of Alcoholics Anonymous (AA). Here, the authors review their work on links between AA attendance and reduced impulsivity using a 16-year prospective study of men and women with alcohol use disorders (AUDs) who were initially untreated for their drinking problems. Across the study period, there were significant mean-level decreases in impulsivity, and longer AA duration was associated with reductions in impulsivity. In turn, decreases in impulsivity from baseline to Year 1 were associated with fewer legal problems and better drinking and psychosocial outcomes at Year 1, and better psychosocial functioning at Year 8. Decreases in impulsivity mediated associations between longer AA duration and improvements on several Year 1 outcomes, with the indirect effects conditional on participants' age. Findings are discussed in terms of their potential implications for research on AA and, more broadly, interventions for individuals with AUDs.

Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment

BACKGROUND AND OBJECTIVES

This prospective study uses path analytic models to examine baseline characteristics associated with both functioning and drinking outcomes 12 months after inpatient alcohol treatment.

METHODS

Alcohol-dependent participants (N = 101) were recruited during inpatient alcohol treatment and assessed monthly 1 year after discharge.

RESULTS

Alcohol severity was negatively associated with education and self-efficacy; marital status was positively associated with self-efficacy; and education and self-efficacy were negatively associated with drinking outcomes. Low alcohol severity, not having a depression diagnosis, and being married were associated with less social support impairment, which was in turn associated with better drinking outcomes. Having a history of sexual abuse did not influence drinking outcomes. However, having a history of sexual abuse was negatively associated with global functioning.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Drinking outcomes were associated with education, self-efficacy, social support, and diagnosis of depression at baseline; however, global functioning 1 year following treatment was primarily and negatively associated with sexual abuse history. Future treatment research should include measures of both functioning and drinking behavior outcomes.

I think I can't: drink refusal self-efficacy as a mediator of the relationship between self-reported drinking identity and alcohol use

This study examined the relationship between self-reported drinking identity (SRDI), defined as how closely individuals believe drinking is a crucial aspect of their identity (Conner, Warren, Close, & Sparks, 1999), and alcohol use by considering drink-refusal self-efficacy (DRSE) as a potential mediator. Based on previous findings, we expected that SRDI would be negatively associated with DRSE and positively associated with drinking, and that DRSE would be negatively linked with drinking. Further, we expected that DRSE would mediate the association between SRDI and drinking. Participants included 1069 undergraduate students (M age=22.93years, SD=6.29, 76.25% female) from a large southern university who completed computer-based study materials. Gender was associated with SRDI, each of the DRSE subscales, and drinking, indicating that males report greater SRDI, lower DRSE, and increased alcohol consumption. Consistent with expectations, SRDI was negatively linked with DRSE and positively linked with drinking. DRSE subscales were negatively associated with drinking. Further, four measurement models for latent variables were tested for SRDI and each of the three DRSE subscales. Results showed that the emotional relief and social subscales of DRSE mediated the association between SRDI and drinking, however this mediating relationship did not emerge for the opportunistic subscale. Implications of these results are discussed.

Drink refusal self-efficacy and implicit drinking identity: an evaluation of moderators of the relationship between self-awareness and drinking behavior

This study evaluated the roles of drink refusal self-efficacy (DRSE), implicit drinking identity, and self-awareness in drinking. Self-awareness (assessed by public and private self-consciousness), DRSE, and implicit drinking identity (measured via an implicit association test; IAT) were expected to interact in predicting self-reported drinking. This research was designed to consider mixed findings related to self-awareness and drinking. Hypotheses were: 1) alcohol-related outcomes would be negatively associated with self-awareness; 2) implicit drinking identity would moderate the association between self-awareness and alcohol consumption; and 3) this association would depend on whether participants were higher or lower in drink refusal self-efficacy. Participants included 218 undergraduate students. Results revealed that drinking behavior was not associated with self-awareness but was positively associated with implicit drinking identity. Of the four drinking variables (peak drinking, drinking frequency, drinks per week, and alcohol-related problems), only alcohol-related problems were positively associated with self-awareness. Furthermore, a significant two-way interaction emerged between private (but not public) self-consciousness and drinking identity to predict drinking. Consistent with expectations, three-way interactions emerged between self-awareness, implicit drinking identity, and DRSE in predicting drinking. For participants low in DRSE: 1) high implicit drinking identity was associated with greater drinking frequency when private self-consciousness was low; and 2) high implicit drinking identity was associated with greater drinks per week and peak drinks when public self-consciousness was low. This suggests that alcohol-related IATs may be useful tools in predicting drinking, particularly among those low in self-awareness and DRSE.

Can you say no? Examining the relationship between drinking refusal self-efficacy and protective behavioral strategy use on alcohol outcomes

Preliminary research has demonstrated reductions in alcohol-related harm associated with increased use of protective behavioral strategies (PBS) and higher levels of drinking refusal self-efficacy (DRSE). To extend research that has evaluated these protective factors independently of one another, the present study examined the interactive effects of PBS use and DRSE in predicting alcohol outcomes. Participants were 1084 college students (63% female) who completed online surveys. Two hierarchical linear regression models revealed that both DRSE and PBS use predicted alcohol use and consequences. Additionally, DRSE moderated the relationship between PBS use and both typical weekly drinking and negative alcohol-related consequences, such that participants who reported lower levels of PBS use and DRSE in the social pressure or emotional regulation dimensions were at greatest risk for heavy drinking and consequences respectively. Interestingly, for those who reported higher levels of social and emotional DRSE, levels of PBS use had no impact on alcohol use or alcohol consequences respectively. These findings demonstrate that DRSE and PBS use differentially reduce risk, suggesting the utility of collegiate, alcohol harm reduction interventions that aim to both increase PBS use and bolster self-efficacy for greater harm reduction.

Polysubstance use in cannabis users referred for treatment: drug use profiles, psychiatric comorbidity and cannabis-related beliefs

BACKGROUND

Population-based surveys demonstrate cannabis users are more likely to use both illicit and licit substances, compared with non-cannabis users. Few studies have examined the substance use profiles of cannabis users referred for treatment. Co-existing mental health symptoms and underlying cannabis-related beliefs associated with these profiles remains unexplored.

METHODS

Comprehensive drug use and dependence severity (Severity of Dependence Scale-Cannabis) data were collected on a sample of 826 cannabis users referred for treatment. Patients completed the General Health Questionnaire, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire, and Positive Symptoms and Manic-Excitement subscales of the Brief Psychiatric Rating Scale. Latent class analysis was performed on last month use of drugs to identify patterns of multiple drug use. Mental health comorbidity and cannabis beliefs were examined by identified drug use pattern.

RESULTS

A three-class solution provided the best fit to the data: (1) cannabis and tobacco users (n = 176), (2) cannabis, tobacco, and alcohol users (n = 498), and (3) wide-ranging substance users (n = 132). Wide-ranging substance users (3) reported higher levels of cannabis dependence severity, negative cannabis expectancies, lower opportunistic, and emotional relief self-efficacy, higher levels of depression and anxiety and higher manic-excitement and positive psychotic symptoms.

CONCLUSION

In a sample of cannabis users referred for treatment, wide-ranging substance use was associated with elevated risk on measures of cannabis dependence, co-morbid psychopathology, and dysfunctional cannabis cognitions. These findings have implications for cognitive-behavioral assessment and treatment.

The concepts of rash impulsiveness and reward sensitivity in substance use disorders

According to recent theories of addiction, the commonly used term impulsivity comprises two factors: rash impulsiveness and reward sensitivity. The present study addresses the relevance and generalizability of this two-factor model in a clinical sample of substance use disorder patients. This was examined by examining both internal and external validity. In addition, a comparison was made between self-reported and behavioral measures reflecting reward sensitivity and rash impulsiveness. Results provide evidence for the existence of the two hypothesized impulsivity factors in a clinical sample of substance dependent patients. Meaningful relationships between the model and drug use characteristics have been found, providing further evidence for the validity of the two-factor model. Furthermore, it is suggested that behavioral and self-report measures of impulsivity represent different constructs.

Determinants of early alcohol use in healthy adolescents: the differential contribution of neuroimaging and psychological factors

Individual variation in reward sensitivity may have an important role in early substance use and subsequent development of substance abuse. This may be especially important during adolescence, a transition period marked by approach behavior and a propensity toward risk taking, novelty seeking and alteration of the social landscape. However, little is known about the relative contribution of personality, behavior, and brain responses for prediction of alcohol use in adolescents. In this study, we applied factor analyses and structural equation modeling to reward-related brain responses assessed by functional magnetic resonance imaging during a monetary incentive delay task. In addition, novelty seeking, sensation seeking, impulsivity, extraversion, and behavioral measures of risk taking were entered as predictors of early onset of drinking in a sample of 14-year-old healthy adolescents (N=324). Reward-associated behavior, personality, and brain responses all contributed to alcohol intake with personality explaining a higher proportion of the variance than behavior and brain responses. When only the ventral striatum was used, a small non-significant contribution to the prediction of early alcohol use was found. These data suggest that the role of reward-related brain activation may be more important in addiction than initiation of early drinking, where personality traits and reward-related behaviors were more significant. With up to 26% of explained variance, the interrelation of reward-related personality traits, behavior, and neural response patterns may convey risk for later alcohol abuse in adolescence, and thus may be identified as a vulnerability factor for the development of substance use disorders.